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~NO'J003337 OfFlCfA(R:iw
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bit
; RECEIVED
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o. 10 77/100
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~gllars
From:
representing Pennsylvania Inheritance or
Estate Tax due from the following eS,tote:
Address
2%Taxan
$
$
$
$
$
$
$ , .. 1'7
$
Sh.i.pJlena~ .
Pa.
17257
6% Tox on
$
F;
~a, <l1-7e~JO Date of Death6-'G-197S
15% Tax on $
, of Payment 3"':1 '5, 1"".
% Tax on $
Estate Tax, Act of
May 7, 1927
Nome of Decedent ..altaR J 11 u.~
Cau nty
CwaberlaDd
TOTAL TAX CREDIT
less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
_%from
to
$
Remarks:
-... -'AIl) DlI'DLL-
'j]' 00 ~ [p [L ~ @ illlj'[~
5 E A L
TOTAL AMOUNT PAID $ \
'1 f:; I I \
\ (XQA -1 AcCV /1
(SiQnature) '-
Ilicharca JS. ADd.non
a.g1.~~1 f will.
Ite
1.77
NOTE: This Triplicate Receipt to be rehIined for 8udit purposes.
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Received by
NOTE: In occepling the transfer inheritance taX on future estates, prior to the death of the life
lenonl or tenent for years, os evidenced by this rtKeipt, it is understood Ihat the Commonwealth shall
not be precluded or prevented from hereaher assessing additional inheritance tall: ot the death of the
Iif. tenont or tenonl for years whenever II appears Ihal such additional tax may be legolly due and
collectible for ony reason whatsoever.
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